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[目的]旨在探讨奥曲肽联合置入胰管支架预防胆总管结石伴插管困难患者ERCP术后胰腺炎的效果。[方法]选取本院内镜中心于2014年1月~2016年6月间收治行ERCP术胆总管结石伴插管困难患者50例作为研究对象,随机数字表法将患者分为观察组25例和对照组25例。行EPCP术后,对照组患者接受术后抑酸、抑酶、抗炎、补液、对症支持治疗,在此基础上,观察组患者接受术后静脉泵入奥曲肽注射和术中后置入胰管支架治疗。观察和比较2组患者症状消失时间、住院时间和治疗费用。观察和比较2组患者术后胰腺炎(PEP)、高淀粉酶血症发生情况。测定和比较2组患者术后3h和术后24h血清淀粉酶(AMS)表达、降钙素(PCT)和血清C反应蛋白(CRP)表达。[结果]对照组患者PEP发生率44%和高淀粉酶血症发生率28%明显高于观察组患者12%和4%,差异有统计学意义(P<0.05)。术后3h,对照组患者血清AMS表达(1388±468)U/L明显高于观察组患者AMS表达(364±424)U/L,差异有统计学意义(P<0.05),2组患者PCT和CRP表达差异无统计学意义(P<0.05);术后24h,2组患者AMS表达差异无统计学意义(P>0.05),观察组患者PCT和CRP表达低于对照组患者,差异有统计学意义(P<0.05)。观察组患者治疗费用高于对照组患者,住院时间低于对照组患者,差异无统计学意义(P>0.05),症状消失时间低于对照组患者,差异有统计学意义(P<0.05)。[结论]奥曲肽联合置入胰管支架可显著降低胆总管结石伴插管困难患者ERCP术后PEP及高淀粉酶血症发生率,值得临床推广。
[Objective] To investigate the effect of octreotide combined with pancreatic duct stenting in the prevention of post-ERCP pancreatitis in patients with common bile duct stones and intubation. [Methods] Fifty cases of ERCP patients with choledocholithiasis and intubation difficulties admitted to our hospital from January 2014 to June 2016 were selected as subjects. The patients were divided into observation group (n = 25) And control group of 25 cases. After EPCP, patients in the control group received postoperative acid suppressive, antiproliferative, antiinflammatory, rehydration and symptomatic supportive therapy. On this basis, the patients in the observation group received postoperative intravenous injection of octreotide and intraoperative implantation of pancreatic duct Stent treatment. The symptom disappearance time, hospitalization time and treatment cost were observed and compared in two groups. Observe and compare the postoperative pancreatitis (PEP) and hyper amylasemia in the two groups. The levels of serum amylase (AMS), calcitonin (PCT) and serum C-reactive protein (CRP) were measured and compared at 3h and 24h after operation in both groups. [Results] The incidence of PEP in control group was 44% and that in hyperpyreticosis 28% was significantly higher than that in observation group 12% and 4%, respectively. The difference was statistically significant (P <0.05). At 3h, the serum AMS expression in the control group (1388 ± 468) U / L was significantly higher than that in the observation group (364 ± 424) U / L, the difference was statistically significant (P <0.05) (P <0.05). There was no significant difference in AMS expression between the two groups (P> 0.05). The expression of PCT and CRP in the observation group was lower than that in the control group Significance (P <0.05). The cost of treatment in observation group was higher than that in control group, and the hospitalization time was lower than that in control group. There was no significant difference (P> 0.05). The disappearance time of symptom was lower than that of control group (P <0.05). [Conclusion] The combination of octreotide with pancreatic stent placement can significantly reduce the incidence of PEP and hyper amylasemia after ERCP in patients with choledocholithiasis complicated with intubation, which is worthy of clinical application.